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Robotic-Assisted Surgery: Repairing the Heart

It was easy for René LePage to dismiss the extreme exhaustion. Like many wives and mothers, she wore a number of hats—employee, community volunteer, tutor, chauffeur, cook—so she didn’t think too much of it when she began dropping off to sleep early every evening.

“Women tend to rationalize about themselves,” the 48-year-old Long Beach native says. “If my husband were feeling overly tired, I’d say, ‘Call the doctor.’ But with me, I thought, ‘I work full time. I have a house to keep. I have three teenagers who keep me busy. So if I’m tired, I have reason to be tired.’”

Despite her busy life, René had regular cardiac checkups to avoid the severe heart problems other family members had experienced. So she was surprised when her OB/GYN detected a heart murmur during a routine exam.

Follow-up tests with her cardiologist revealed a shocking diagnosis: René’s mitral valve, which controls the flow of blood from the lungs into the left ventricle, wasn’t closing properly, making her heart work harder than it should. Called mitral valve regurgitation, the condition was responsible for her exhaustion and could eventually lead to other serious heart problems.

Within days, René met with Daniel Bethencourt, M.D., a cardiothoracic surgeon at Long Beach Memorial. After examining her, he proposed a leading-edge approach to repair her valve: robot-assisted surgery.

“Traditional mitral valve surgery requires a 12-inch incision in the center of the chest, as well as splitting the breastbone and spreading the rib cage,” says Dr. Bethencourt. “Using the da Vinci S Surgical System, the mitral valve can be repaired through four small incisions.”

“I was just amazed when I learned about robotic surgery and felt fortunate that Long Beach Memorial had this to offer me,” says René.

The da Vinci robot is a marvel to behold. Seven-feet tall with three arms, it’s controlled by a surgeon who sits at a console steps away from the patient. During surgery, a stereoscopic video camera, held by one of the robot’s arms, is inserted into the body through a small incision. The robot’s other arms hold miniature surgical instruments, which are inserted through other tiny incisions. By manipulating joy-stick-like grippers, the surgeon controls the surgical instruments, camera and robotic arms.

“The camera can magnify the surgical field up to 15 times, generating high-definition, full-color, three-dimensional images,” says Dr. Bethencourt. “The machine’s advanced design allows the robot’s “hands” to be more flexible and steady than humanly possible. And a feature called motion scaling reduces the surgeon’s hand motions to mini-movements, making the robotic system ideal for working in tight spaces such as the heart cavity.” As a result, surgery can be more precise than ever before possible.

During René’s six-hour mitral valve repair, Dr. Bethencourt never once touched her heart. With pinpoint accuracy, he repaired the mitral valve using the da Vinci robot and microsurgical techniques. Just days after her complex surgery, René began cardiac rehabilitation at Long Beach Memorial, which included taking daily walks around the block. Today, her life is back on track—literally. She walks three miles every day and returned to work in April. “Now I can stay awake,” she says. “I finally have a normal person’s hours again.”